Tibia plafond fractures have historically demonstrated high complication rates. The purpose of this study was to assess the outcomes of tibia plafond fractures following treatment with definitive external fixation vs delayed open reduction and internal fixation (ORIF). Sixty patients were enrolled in a prospective cohort trial at 1 Level I trauma center. No differences were noted between the 2 treatment groups in terms of age, smoking history, presence of comorbidities, mechanism of injury, incidence of open fractures, or Orthopaedic Trauma Association fracture classification. Complete 12-month follow-up was available for 18 patients in the definitive external fixation group and 27 patients in the ORIF group. No difference was noted in articular reduction between the groups at 6 and 12 months postoperatively. Delayed union or non-union occurred in 4 (22.2%) of 18 patients in the external fixation group and 1 (3.7%) of 27 patients in the ORIF group (P=.05). Deep infection was equally likely in either group (P=.33). The ORIF group had improved Iowa Ankle Scores at 6 (23.6 ± 12.1 vs 11.1 ± 7.7; P<.05) and 12 months (5.5 ± 2.2 vs 3.1 ± 1.7; P<.05) postopertively and improved Short Form-36 Physical Function scores at 6 months (49.7 ± 30.1 vs 25.5 ± 8.0; P<.05) postoperatively compared with the external fixation group.External fixation and ORIF can attain bony union with adequate articular reduction and similar infection rates. Patients treated with ORIF appeared to have improved union rates and early outcomes with ankle function and Short Form-36 Physical Function scores.

BackgroundMetallic reconstruction plates used for fracture stabilization typically require intraoperative contouring for patient-specific anatomical fit. Despite this, characterization of plate mechanical properties after contouring has previously been limited.The objective of this study was to assess whether contouring affects fatigue resistance for three types of Stryker seven-hole stainless steel (SS) 316LVM fracture fixation plates. The hypothesis was that for each plate type, more contouring repetitions would result in lower fatigue resistance.MethodsPlates were contoured using a bench-top plate bender to ±20° either 0×, 3×, 6×, or 9× (n = 5 per group) and tested in the straight configuration. Cyclic four-point bending was applied in an incremental stepwise staircase approach (one step = 100,000 cycles, 10 Hz) until failure (defined as brittle fracture or plastic deformation of 10° permanent bend). Moment-cycle product (MCP) was computed as the summation of maximum moment × number of cycles and used as the primary measure of fatigue resistance.ResultsNo significant differences in fatigue resistance were detected between contouring groups for Basic Fragment Set (BFS) Reconstruction Plates. Significantly lower fatigue resistance was measured for 9× contoured Matta Pelvic System (MPS) Straight Plates compared to 0× contoured plates (p = 0.023). MPS Flex Plates contoured 3× had greater fatigue resistance than 0× contoured (p = 0.031) and 9× contoured plates (p = 0.032).ConclusionsThis work provides fatigue resistance-based evidence that clinicians should avoid high repetitions of contouring for MPS Straight Plates. Meanwhile, BFS Reconstruction Plates and MPS Flex Plates are not negatively affected by contouring. These results allow for improved intraoperative decisions about using or discarding plates after multiple contouring repetitions.

Background To reduce wear, the ideal bearing surface in joint arthroplasty should be smooth and hydrophilic. Ceramics generally offer better wettability than metals and can be polished to a smoother finish. However, clinical studies have found no reduction in liner wear when using yttria-stabilized zirconia (Y-TZP) instead of cobalt chromium alloy (CoCr) femoral heads. Question/purposes We (1) determined whether a hard, diamond-like carbon (DLC) coating would enhance the wettability of CoCr and magnesia-stabilized zirconia (Mg-PSZ) femoral heads without increasing roughness, and (2) compared their wear performance. Methods In an observational study limited to CoCr and Mg-PSZ heads, we measured roughness and contact angle on as-received and DLC-coated heads. Eight heads then were subjected to 11 million cycles of wear in a hip simulator against cross-linked ultrahigh molecular weight polyethylene (XLPE) liners.Results Mg-PSZ femoral heads were smoother and more hydrophilic than CoCr heads. Although DLC coatings did not reduce roughness, they reduced the contact angle of CoCr and Mg-PSZ substrates, which may provide enhanced lubrication in vivo. In hip simulator tests, liners bearing against CoCr heads wore at a greater rate compared with Mg-PSZ heads. The DLC coating on Mg-PSZ heads did not reduce wear further. Conclusions The wear rate of XLPE versus Mg-PSZ was seven times less than CoCr heads, probably owing to lower roughness and greater wettability of Mg-PSZ heads. Clinical relevance The use of Mg-PSZ femoral heads should lead to reduced wear in vivo compared with CoCr heads, but the clinical benefit of DLC-coated Mg-PSZ is unclear.

Ankle arthroscopy has been used successfully in the treatment of osteochondral lesions of the talus since the 1980s. Published studies during the 1990s up until present day have shown it as an asset to confirm reduction, limit the surgical exposure and soft-tissue trauma, and to diagnose and treat associated intra-articular pathology in displaced ankle fractures. The objective of this paper is to review the available literature and describe the technique when utilizing arthroscopy in ankle fractures. Level of Evidence: Diagnostic Level 4. See Instructions for Authors for a complete description of levels of evidence.FIGURE 2. A, AP ankle with fibula fracture and syndesmotic/medial clear space widening. B, AP ankle post-ORIF. C, Arthroscopic view showing syndesmotic widening >2 mm. D, Arthroscopic view showing syndesmotic reduction.

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